Report Finds Drug Errors at Health Care Facilities
September 13, 2002 -- Medication errors occur at the rate of 1 in 5 doses in a typical hospital or skilled nursing home, according to a recent study of Colorado and Georgia health care facilities (Arch Intern Med 2002 Sep 9; 162(16): 1897-903). About 7% of these drug errors have the potential to jeopardize a patient's health and safety or cause serious discomfort. In many hospitals, the statistic translates into more than 40 harmful drug errors per day per 300 patients.
Investigators looked at the drug delivery systems of a total of 36 accredited hospitals, non-accredited hospitals, and skilled nursing homes. Using trained nurses and pharmacy technicians as observers and a clinical pharmacist to verify results, they calculated the number and type of medication errors. A "medication error" is a dose administered differently than as ordered on the patient's medical record. Errors include giving the wrong drug, omitting a dose, not providing the drug on schedule, and providing it in the wrong manner (e.g. in oral rather than in injectable form).
Most of the errors involved providing a dose at the wrong time or omitting it entirely. The error rate did not differ based on the type of facility, and hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations did not necessarily have lower error rates.
The medication error rates are likely to be understated because many facilities declined to participate in the study, citing medical issues which they were in the process of addressing. The study results imply that the medication delivery and administration systems of the nation's hospitals and skilled nursing facilities may have major systems problems.